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Individual

CATHLEEN C SHEPHERD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2655 DALLAS HWY SW, SUITE 320, MARIETTA, GA 30064-2597
(404) 314-7518
(770) 434-3999
Mailing address
2896 KNOB HILL DR SE, ATLANTA, GA 30339-4201
(770) 434-3999
(770) 434-3999

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT000009
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000624126C
PEACH STATE HEALTH PLAN
GA
05
000624126C
GA
01
10035954
AMERIGROUP
GA
01
312669
WELLCARE
GA
01
52171845 001
BLUE CROSS BLUE SHIELD
GA
01
52171845 002
BLUE CROSS BLUE SHIELD
GA
01
52171845 003
BLUE CROSS BLUE SHIELD
GA
Enumeration date
11/14/2006
Last updated
07/08/2007
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